Provider Demographics
NPI:1003244575
Name:DORITY, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DORITY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 TIETON DR
Mailing Address - Street 2:3
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-4907
Mailing Address - Country:US
Mailing Address - Phone:509-952-8476
Mailing Address - Fax:509-965-0463
Practice Address - Street 1:5017 TIETON DR
Practice Address - Street 2:3
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4907
Practice Address - Country:US
Practice Address - Phone:509-952-8476
Practice Address - Fax:509-965-0463
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-21
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60405083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist